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PERMIT APPLICATIO�V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857—www.everettwa.org <br /> I� - a3�-vy <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT &�REDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRE�S PARCEL TAX I.D.# PERMIT# <br /> �0� 2,�� I r}- v�e�� Dr �vz,�l- ,�1oy � -03 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> �OWNER ADDRESS CITY2IP PHONE <br /> S ��.ra�-, 1� I �—,1— C� �1 z� 2rr:-��� i�� ���e-`r�— �3�5-S`��� <br /> TENANT NAME CONTACT FOR PERMIT PHONE (c���ZSZ„�'-7(�, 3 <br /> �3� b �S �� r-. .� c �.���-�s 2a��� <<�-� y2s-zs��y�� T. <br /> CONTRACTOR `l�l ��) I����S �DD SS � y CITY21IP,�, S�-�PHON�Z� ZS���,I Q <br /> •YJ CC;.-•5. ��(� � CS� �Zstc' �`21C�'J �c.,�.;� `r <br /> CONTR.LIiENSE# /�C �� -C ur+ i lZ C� �3Z�S_ ''J�n..�l� �L Q 1 1���71�LW�O C�3�C I <br /> ��?• ,°.�� l. <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �5�����.�.,\ l ,�,Eiectric _Gas_Other Tit7-�r1`, <br /> i WORKDESCRIPTION � ^S�I \ C7/� S 1�/PI� •� L�1 IneC- YCC�K��' �(�Q�`�e� <br /> ' �� IIC�� s��.�r�:`.� �.1 �"� ��-S '�-Q ����� ���i: l 1'i� I1�"T�-r US\u[ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) � Gas piping <br /> Shower � Waterheater <br /> Kitchen sink 8 disposal _� Gas fireplace <br /> Dishwasher _j_ Gas range <br /> Clolhes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/badmop/etc.) _ Exhaust fan <br /> Back(low pievenler _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Re(rigeration <br /> Grease lrap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be lrue and cortect. All provisions of laws and <br /> ordinaces governing this rype of work will be complied with whether specified herein or noL The granling of a permit does not presume <br /> to 9ive authoriry to violate or cancel the provision of any other state or local law regulating constructlon or lhe performance of <br /> construction.That I am authorized by the owner of lhis property to perform the work for which .pplication is made and I comply with the <br /> Slate Contraclors Law 18.27 RCW and 296.200 WP.C. <br /> C��_�—r� � � �2 3� L �{— <br /> Signature o(OwnedContracior/Aulhonze g� Date <br />